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Cajun Nurse

Cajun Nurse

Corporate Compliance ICU, US Army ret
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Cajun Nurse has 34 years experience and specializes in Corporate Compliance ICU, US Army ret.

Cajun Nurse's Latest Activity

  1. Cajun Nurse

    Nurse Practice Act question, can RN's write orders?

    during my army career i was an intensive care nurse for ten of those years. at eisenhower army medical center our physicians would write our order for vasopressors, insulin drips and heparin as titrate to a specific value depending on the drip and call me if …. that is how we managed therapeutics that are as we would say fluid. there was no need to write orders for changes, but our nursing documentation had to be very complete and precise. in my world verbal orders are a serious concern. the expectation of cms is that verbal orders are accepted by licensed personnel (nurse, pharmacist). cms put this wording into 42 cfr 482.23©(2)(i) if verbal orders are used, they are to be used infrequently. this is in the cms world is recognized as a safety issue. cms’ approach is if a patient needs a lot of verbal orders maybe the physician needs to be present directing the care. it is interesting that cms put this regulatory line only in the nursing conditions of participation. this would lead one to think that nurses are, as the patient advocate, expected to tell the physician enough i am not taking another verbal order because i need you here. i realize the problems that may cause, been there done that. lastly a verbal order must be spoken and the nurses in my hospital will only take telephone orders. if the physician is present they are handed to chart. and the requirement for the authentication of that order is actually written as promptly and failing that, within 48 hours. i have had reports from fellow compliance professionals that their facility was cited by cms when the verbal order was signed within 48 hours because the issue at hand was critical and the physician should have come in after giving the order to check on the patient. some may say that is unreasonable. i personally have sat with cms folks and they can be very insistent. reference: state operations manual, appendix a survey protocols. regulations and interpretative guidelines for hospitals. this is a lot and i hope you find it helpful. richard
  2. Cajun Nurse

    Nurse Practice Act question, can RN's write orders?

    the answer is no. the medicare conditions of participation state that medicare partients are under the care of a md/do. most facilities apply these standards to all patients as it is the most exacting standard. i had a discussion with the lead surveyor in cms region x and here guidance was that for inpatient orders all midlevel orders must be co-signed to demonstrate physician involvement. believe me i would not have dreamed of inquiring about an rn writing an order after our conversation. oh i am an rn compliance analyst so this is my life to answer these questions.
  3. Cajun Nurse

    Being Sued / Losing License

    I have been a registered Nurse for 36 years and my answer to all has been one. It was part of an investigation that I was conducting with Medicaid. My roll was to provide the evidence to the Board of Nursing. You my feel comfortable in the knowledge that this was a very good thing for the profession. As for me I was actually upset with this nurse in that his choice to be unprofessional and abusive to his clients placed me in a position to report him to the BON. Nurses need to remember and think before they act. There are some of us in regulatory roles and it actually is very distastful to us find nurses behaving poorly and being placed in a position to act against a fellow nurse. The bottom line is that it the patient that counts and our charge is to protect the patient and the public. Richard
  4. Cajun Nurse

    I wish I had studied this before Nursing 101.......

    I would suggest technical and creative writing. They will help with your papers, but in the future as you progress up the ladder you will be happy you aquired those skills.
  5. Cajun Nurse

    Yelling Doctors, How do you handle them?????

    first the call to the doc is a requirement under the conditions of participation, the joint commission and plain old provision of quality care. the behavior is unacceptable and is addressed in the joint commission standards, any quality rules and regulations of the medical staff and in alaska is cited as unprofessional conduct in the alaska medical board statues and regulations. the ama policies at their web site prohibit this behavior. you are not dealing with a professional but rather a bully. this needs to be report to your medical executive committee. i must admit that i really enjoyed miko 014's strategy for addressing this behavior.
  6. Cajun Nurse

    Life Just Sucks Sometimes

    This is a really great article. I would hope that the writer sends it to NPR. This would be a very meanful This I Belive segment.
  7. Cajun Nurse

    I hate nursing

    I have been in Nursing for 34 years and actually really do love the job. I think it is important to understand how you feel about your profession. You should give consideration to finding something you really enjoy doing and go into that field. Any amount of time that you spend doing something you hate is damaging to yourself and the others around you. Life can be too short to be unhappy in your endevors.
  8. Cajun Nurse

    Certification in Healthcare Compliance

    i am curious as to how many nurses are certified in healthcare compliance. i became certified in 2005 and have seen a few certified rns at our national conferences. there are journal articles from nurses also. compliance is a very worthwhile field for nursing and can be very demanding. i would recommend that anyone interested consider the health care compliance association (hcca). it is the first nationally organized compliance association. the health care compliance board (hccb) oversees compliance certification testing and also certifies compliance programs in the nation. the hccb is a part of the larger organization. membership is $150 per year for governmental employees. i have added the urls for the home page, the certification section and the book store. in the book store you will find two texts, compliance 101 2nd edition and auditing and monitoring. i recommend both. debbie troklus one of the authors of 101 is the president of hccb and is responsible for all the certifications. 101 is the text book for the compliance academies. if you have any training funds the compliance academy is the ideal way to go. there is one in december in san diego. you will find that notice on the home page and scroll down. the next alternative is attending a compliance institute to obtain the ceus, study the books and test after the institute. the next one is in las vegas in april. http://www.hcca-info.org/am/template.cfm?section=home http://www.hcca-info.org/am/template.cfm?section=chc_certification http://www.hcca-info.org/am/template.cfm?section=shop_online
  9. Cajun Nurse

    what do nurses hate about doctors?

    you have hit the nail on the head. the issue is nursing leadership. there is a huge difference between a leader and a manager. in the army nurse corp this behavior is not tolerated. we have conditions of participation for hospitals in our federal regulations and now our joint commission has a standard related to disruptive behavior. the office of the inspector general and centers for medicare and medicaid are looking at this disruptive behavior as a quality of care issue. so there is shift towards lack of tolerance. i expect to changes in the not to distant future. i have also noted that the abusive behavior is not uniformly applied. the stronger female and male nurses do not experience this. what we are actually dealing with are bullies. they have a tendency to be cowardly when they run into resistance. our colleague from down under has the approach. the nurse manager needs to put on the leader hat and standup for their staff. remember the old army slogan no gut no glory. it applies everywhere.
  10. Cajun Nurse

    what do nurses hate about doctors?

    My current pet peeve is practitioner orders specifically physician verbal orders. First if you are present write and authenticate your own order. If you are not present then make it a point to review the verbal order for accuracy and actual implementation. Then sign your orders. This is a patient safety issue. There is also the issue that the nurse took the verbal order in good faith. It is the physician's responsibility to follow through with the authentication to make the order a legal one.